Rapid testing for group B streptococcus during labour: a test accuracy study with evaluation of acceptability and cost-effectiveness

OBJECTIVE: To determine the accuracy, acceptability and cost-effectiveness of polymerase chain reaction (PCR) and optical immunoassay (OIA) rapid tests for maternal group B streptococcal (GBS) colonisation at labour. DESIGN: A test accuracy study was used to determine the accuracy of rapid tests for GBS colonisation of women in labour. Acceptability of testing to participants was evaluated through a questionnaire administered after delivery, and acceptability to staff through focus groups. A decision-analytic model was constructed to assess the cost-effectiveness of various screening strategies. SETTING: Two large obstetric units in the UK. PARTICIPANTS: Women booked for delivery at the participating units other than those electing for a Caesarean delivery. INTERVENTIONS: Vaginal and rectal swabs were obtained at the onset of labour and the results of vaginal and rectal PCR and OIA (index) tests were compared with the reference standard of enriched culture of combined vaginal and rectal swabs. MAIN OUTCOME MEASURES: The accuracy of the index tests, the relative accuracies of tests on vaginal and rectal swabs and whether test accuracy varied according to the presence or absence of maternal risk factors. RESULTS: PCR was significantly more accurate than OIA for the detection of maternal GBS colonisation. Combined vaginal or rectal swab index tests were more sensitive than either test considered individually [combined swab sensitivity for PCR 84% (95% CI 79-88%); vaginal swab 58% (52-64%); rectal swab 71% (66-76%)]. The highest sensitivity for PCR came at the cost of lower specificity [combined specificity 87% (95% CI 85-89%); vaginal swab 92% (90-94%); rectal swab 92% (90-93%)]. The sensitivity and specificity of rapid tests varied according to the presence or absence of maternal risk factors, but not consistently. PCR results were determinants of neonatal GBS colonisation, but maternal risk factors were not. Overall levels of acceptability for rapid testing amongst participants were high. Vaginal swabs were more acceptable than rectal swabs. South Asian women were least likely to have participated in the study and were less happy with the sampling procedure and with the prospect of rapid testing as part of routine care. Midwives were generally positive towards rapid testing but had concerns that it might lead to overtreatment and unnecessary interference in births. Modelling analysis revealed that the most cost-effective strategy was to provide routine intravenous antibiotic prophylaxis (IAP) to all women without screening. Removing this strategy, which is unlikely to be acceptable to most women and midwives, resulted in screening, based on a culture test at 35-37 weeks' gestation, with the provision of antibiotics to all women who screened positive being most cost-effective, assuming that all women in premature labour would receive IAP. The results were sensitive to very small increases in costs and changes in other assumptions. Screening using a rapid test was not cost-effective based on its current sensitivity, specificity and cost. CONCLUSIONS: Neither rapid test was sufficiently accurate to recommend it for routine use in clinical practice. IAP directed by screening with enriched culture at 35-37 weeks' gestation is likely to be the most acceptable cost-effective strategy, although it is premature to suggest the implementation of this strategy at present.

Intrapartum tests for group B streptococcus:accuracy and acceptability of screening

Objective: To assess the accuracy and acceptability of polymerase chain reaction (PCR) and optical immunoassay (OIA) tests for the detection of maternal group B streptococcus (GBS) colonisation during labour, comparing their performance with the current UK policy of risk factor-based screening. Design Diagnostic test accuracy study. Setting and population Fourteen hundred women in labour at two large UK maternity units provided vaginal and rectal swabs for testing. Methods The PCR and OIA index tests were compared with the reference standard of selective enriched culture, assessed blind to index tests. Factors influencing neonatal GBS colonisation were assessed using multiple logistic regression, adjusting for antibiotic use. The acceptability of testing to participants was evaluated through a structured questionnaire administered after delivery. Main outcome measures The sensitivity and specificity of PCR, OIA and risk factor-based screening. Results Maternal GBS colonisation was 21% (19-24%) by combined vaginal and rectal swab enriched culture. PCR test of either vaginal or rectal swabs was more sensitive (84% [79-88%] versus 72% [65-77%]) and specific (87% [85-89%] versus 57% [53-60%]) than OIA (P <0.001), and far more sensitive (84 versus 30% [25-35%]) and specific (87 versus 80% [77-82%]) than risk factor-based screening (P <0.001). Maternal antibiotics (odds ratio, 0.22 [0.07-0.62]; P = 0.004) and a positive PCR test (odds ratio, 29.4 [15.8-54.8]; P <0.001) were strongly related to neonatal GBS colonisation, whereas risk factors were not (odds ratio, 1.44 [0.80-2.62]; P = 0.2). Conclusion Intrapartum PCR screening is a more accurate predictor of maternal and neonatal GBS colonisation than is OIA or risk factor-based screening, and is acceptable to women. © RCOG 2010 BJOG An International Journal of Obstetrics and Gynaecology.

An integrated assessment model for cross-country pipelines

The cross-country petroleum pipelines are environmentally sensitive because they traverse through varied terrain covering crop fields, forests, rivers, populated areas, desert, hills and offshore. Any malfunction of these pipelines may cause devastating effect on the environment. Hence, the pipeline operators plan and design pipelines projects with sufficient consideration of environment and social aspects along with the technological alternatives. Traditionally, in project appraisal, optimum technical alternative is selected using financial analysis. Impact assessments (IA) are then carried out to justify the selection and subsequent statutory approval. However, the IAs often suggest alternative sites and/or alternate technology and implementation methodology, resulting in revision of entire technical and financial analysis. This study addresses the above issues by developing an integrated framework for project feasibility analysis with the application of analytic hierarchy process (AHP), a multiple attribute decision-making technique. The model considers technical analysis (TA), socioeconomic IA (SEIA) and environmental IA (EIA) in an integrated framework to select the best project from a few alternative feasible projects. Subsequent financial analysis then justifies the selection. The entire methodology has been explained here through a case application on cross-country petroleum pipeline project in India.

IUPHAR-DB:the IUPHAR database of G protein-coupled receptors and ion channels

The IUPHAR database (IUPHAR-DB) integrates peer-reviewed pharmacological, chemical, genetic, functional and anatomical information on the 354 nonsensory G protein-coupled receptors (GPCRs), 71 ligand-gated ion channel subunits and 141 voltage-gated-like ion channel subunits encoded by the human, rat and mouse genomes. These genes represent the targets of approximately one-third of currently approved drugs and are a major focus of drug discovery and development programs in the pharmaceutical industry. IUPHAR-DB provides a comprehensive description of the genes and their functions, with information on protein structure and interactions, ligands, expression patterns, signaling mechanisms, functional assays and biologically important receptor variants (e.g. single nucleotide polymorphisms and splice variants). In addition, the phenotypes resulting from altered gene expression (e.g. in genetically altered animals or in human genetic disorders) are described. The content of the database is peer reviewed by members of the International Union of Basic and Clinical Pharmacology Committee on Receptor Nomenclature and Drug Classification (NC-IUPHAR); the data are provided through manual curation of the primary literature by a network of over 60 subcommittees of NC-IUPHAR. Links to other bioinformatics resources, such as NCBI, Uniprot, HGNC and the rat and mouse genome databases are provided. IUPHAR-DB is freely available at http://www.iuphar-db.org. © 2008 The Author(s).

Radiocarbon dating of mumiyo samples from Antarctica

Radiocarbon dating is a nimportant tool for reconstructing Late Quaternary paleoenvironmental history of the Antarctic continent. Because of the scarcity of datable material, new suitable substances are welcomed. We present here novel paleoenvironmental records subfosil stomach oil deposits (mumiyo). This waxy organic material is found in petrel breeding colonies, especialy in those of snow petrels, Pagodroma nivea. The substance is formed by acumulation and solidifica tion of stomach oil regurgitated for the purpose of defense. We demonstrate and outline the usefulnes and limitations of 14C dating mumiyo for determining dates of local ice retreat, moraines and petrel ocupation history.

Annotated record of the detailed examination of Mn deposits recovered by the Geological Survey of Japan (GSJ) during the 1971-1974 period in the Pacific Ocean

In 1974, the Geological Survey of Japan began its systematic investigation of manganese nodules in the Central Pacific Basin on the new geological research vessel Hakurei Maru. The first cruise (GH 74-5) was carried out over an eastern part area of the Basin (6°-10°30'N, 164°30'-171°30'W), and the authors report here the preliminary results on the occurrence of manganese nodule deposits, paying particular consideration to their relationship to submarine topography and surficial and sub-bottom sedimentary facies. The surveyed area comprises a deep-sea basin at 5,000-5,400 m, defined to the north and east by the chain of seamounts and guyots of the Christmas Ridge. The deep-sea basin is divided roughly into 2 contrasting topographic features. The eastern part is characterised by flattened topography resulting from continuous deposition of turbidities; the meridian and western parts are characterised by gently rolling topography and the existence of a large number of deep-sea hills. Manganese nodules are almost lacking in the former flattened eastern area, whereas they are widely distributed in the latter rolling meridian and western parts. The population density of nodules varies from less than 1 Kg/m² to 26 kg/m² and the higher density is found in the siliceous-calcareous ooze zone of rather small, flat basins surrounded by deep-sea hills. The density is closely related to the thickness of the transparent layer obtained by 3.5 kHz PDR profiling over the whole area. Considering the various data of grab sampling, 3.5 kHz PDR profiling and to a lesser extent of deep-sea television and camera observations, the most promising manganese field in the present area seems to be confined to the north of the western sector of the area.

Observation of manganese coating and encrustation in different environments of the North-Western Atlantic ocean

The major topographic features, or provinces, beyond the continental slope off the Atlantic coast of the United States are (1) Sohm Plain, (2) Hatteras Plain, (3) Nares Plain, (4) Blake Basin, (5) Blake Plateau-Bahama Banks, and (6) Bermuda Rise. The whole of the described area is commonly referred to as the North American Basin. This basin is bounded on the north by Newfoundland Ridge and on the south by Puerto Rico Trench. Topographic features of note within the basin are the divide and the area of depressions between Sohm and Hatteras Plains, the sharply crested Blake Ridge, and the Puerto Rico Ridge. Recently accumulated data on deep-sea oores has given good evidence that the silt and sand covering the abyssal plains are displaced continental sediments in a virtually quartz-free oceanic environment. These sediments were deposited on a primary volcanic bottom. The primary or volcanic bottom is characterized by abyssal hills and seamounts, and the sediment bottom is characterized by abyssal plains, which extend seaward from the continental margins. On the Blake Plateau, bottom photographs and dredge hauls in the axis of the stream show that locally sediment has been removed and the bottom is paved with crusts and nodules of manganese. Photographs and dredged samples from the outer part of the New England Seamount, Chain and Caryn Peak also indicate extensive encrustations of manganese oxide which acts as a binding agent in areas of ooze or other organic debris and thus helps to stabilize the bottom.

Weathering characteristics and lithology of samples from the Rauer Group, Antarctica, obtained in February/March 2007, and conducted with field support of POLARSTERN cruise ANT-XXIII/9

The presence of glacial sediments across the Rauer Group indicates that the East Antarctic ice sheet formerly covered the entire archipelago and has since retreated at least 15 km from its maximum extent. The degree of weathering of these glacial sediments suggests that ice retreat from this maximum position occurred sometime during the latter half of the last glacial cycle. Following this phase of retreat, the ice sheet margin has not expanded more than ~1 km seaward of its present position. This pattern of ice sheet change matches that recorded in Vestfold Hills, providing further evidence that the diminutive Marine Isotope Stage 2 ice sheet advance in the nearby Larsemann Hills may have been influenced by local factors rather than a regional ice-sheet response to climate and sea-level change.

Integrated geoarchaeological methods for the determination of site activity areas : A study of a Viking Age house in Reykjavik, Iceland

Acknowledgements The excavation was funded by the City of Reykjavík, and the geoarchaeological research was funded by a SSHRCC Doctoral Fellowship from the government of Canada, an Overseas Research Studentship, the Cambridge Commonwealth Trust, Pelham Roberts and Muriel Onslow Research Studentships from Newnham College, Cambridge, and Canadian Centennial Scholarships from the Canadian High Commission in London. Garðar Guðmundsson took the micromorphology samples, and supervised sampling on site. The bones were counted by Clayton Tinsley, the thin sections were made by Julie Boreham, and Steve Boreham and his team in the Department of Geography, University of Cambridge, provided technical support for all of the bulk geochemical analyses that were conducted by K. Milek, except for ICP–AES, which was conducted by ALS Chemex. Our gratitude is extended to Charles French, Catherine Hills, Peter Jordan and two anonymous reviewers for their support and helpful comments on earlier drafts of this paper, and to Óskar Gísli Sveinbjarnarson for his assistance with the figures.

Integrated geoarchaeological methods for the determination of site activity areas : A study of a Viking Age house in Reykjavik, Iceland

Acknowledgements The excavation was funded by the City of Reykjavík, and the geoarchaeological research was funded by a SSHRCC Doctoral Fellowship from the government of Canada, an Overseas Research Studentship, the Cambridge Commonwealth Trust, Pelham Roberts and Muriel Onslow Research Studentships from Newnham College, Cambridge, and Canadian Centennial Scholarships from the Canadian High Commission in London. Garðar Guðmundsson took the micromorphology samples, and supervised sampling on site. The bones were counted by Clayton Tinsley, the thin sections were made by Julie Boreham, and Steve Boreham and his team in the Department of Geography, University of Cambridge, provided technical support for all of the bulk geochemical analyses that were conducted by K. Milek, except for ICP–AES, which was conducted by ALS Chemex. Our gratitude is extended to Charles French, Catherine Hills, Peter Jordan and two anonymous reviewers for their support and helpful comments on earlier drafts of this paper, and to Óskar Gísli Sveinbjarnarson for his assistance with the figures.